{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T14:59:34Z","timestamp":1791471574561,"version":"4.3.4"},"reference-count":17,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epileptic Disorders"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the feasibility of investigating autoimmune etiology in adults with drug\u2010resistant epilepsy (DRE) of unknown origin in resource\u2010limited settings and to develop a pragmatic, hypothesis\u2010generating screening approach to guide autoantibody testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective observational study including adults with DRE of unknown etiology was conducted at a tertiary epilepsy center in Brazil. All patients underwent standardized assessment including inflammatory and autoimmunity markers, brain magnetic resonance imaging (MRI), electroencephalography (EEG), cerebrospinal fluid (CSF) analysis, and application of the APE2 and ACES scores. Clinical, laboratory, and imaging findings were analyzed in the context of published autoimmune\u2010associated epilepsy (AAE) profiles to inform a pragmatic screening strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010six patients (46.2% female; median epilepsy duration: 18.5\u2009years) were included. EEG findings were nonspecific. Six patients developed mesial temporal abnormalities on follow\u2010up MRI. CSF protein elevation was observed in 37.5%, oligoclonal bands in 13.6%, and elevated IgG index in 18.2%. Antinuclear antibodies were detected in 26.9%. APE2 score\u2009\u2265\u20094 was present in 57.7%, while ACES score\u2009\u2265\u20092 occurred in 11.5%. Due to limited access to antibody testing, only one patient underwent CSF autoantibody analysis, confirming high\u2010titer anti\u2010GAD65. Based on integrated clinical, laboratory, and imaging findings, a pragmatic screening algorithm was proposed to prioritize candidates for autoantibody testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>In resource\u2010limited settings, systematic use of accessible clinical and laboratory markers may help identify patients with higher pre\u2010test probability of AAE. A pragmatic screening approach may improve diagnostic efficiency and support individualized decision\u2010making when comprehensive antibody testing is not readily available.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epd2.70439","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T14:37:32Z","timestamp":1791470252000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pragmatic screening for autoimmune\u2010associated epilepsy in drug\u2010resistant epilepsy of unknown etiology in resource\u2010limited settings: A hypothesis\u2010generating study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7647-8447","authenticated-orcid":false,"given":"Tom\u00e1sia O. de H. M.","family":"Frezatti","sequence":"first","affiliation":[{"name":"Department of Neurosciences and Behaviour Sciences Universidade de S\u00e3o Paulo, Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto  Ribeir\u00e3o Preto, S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5570-9055","authenticated-orcid":false,"given":"Ricardo L.","family":"Saute","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Behaviour Sciences Universidade de S\u00e3o Paulo, Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto  Ribeir\u00e3o Preto, S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4222-9041","authenticated-orcid":false,"given":"Veriano Alexandre","family":"J\u00fanior","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Behaviour Sciences Universidade de S\u00e3o Paulo, Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto  Ribeir\u00e3o Preto, S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6860-3487","authenticated-orcid":false,"given":"Frederico N.","family":"Nakano","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Behaviour Sciences Universidade de S\u00e3o Paulo, Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto  Ribeir\u00e3o Preto, S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5990-3306","authenticated-orcid":false,"given":"Marina T. R. P.","family":"Dalio","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Behaviour Sciences Universidade de S\u00e3o Paulo, Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto  Ribeir\u00e3o Preto, S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7756-8882","authenticated-orcid":false,"given":"Tonicarlo R.","family":"Velasco","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Behaviour Sciences Universidade de S\u00e3o Paulo, Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto  Ribeir\u00e3o Preto, S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0558-3519","authenticated-orcid":false,"given":"Jo\u00e3o P.","family":"Leite","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Behaviour Sciences Universidade de S\u00e3o Paulo, Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto  Ribeir\u00e3o Preto, S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5502-4734","authenticated-orcid":false,"given":"Ant\u00f4nio Carlos","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Behaviour Sciences Universidade de S\u00e3o Paulo, Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto  Ribeir\u00e3o Preto, S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2131-9438","authenticated-orcid":false,"given":"Vanessa D.","family":"Marques","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Behaviour Sciences Universidade de S\u00e3o Paulo, Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto  Ribeir\u00e3o Preto, S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1768-2357","authenticated-orcid":false,"given":"Am\u00e9rico C.","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Behaviour Sciences Universidade de S\u00e3o Paulo, Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto  Ribeir\u00e3o Preto, S\u00e3o Paulo 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